Tube Current Modulation Schemes Research Articles

Reconstruction of three-dimensional tomographic patient models for radiation dose modulation in CT from two scout views using deep learning.

A tomographic patient model is essential for radiation dose modulation in x-ray computed tomography (CT). Currently, two-view scout images (also known as topograms) are used to estimate patient models with relatively uniform attenuation coefficients. These patient models do not account for the detailed anatomical variations of human subjects, and thus, may limit the accuracy of intraview or organ-specific dose modulations in emerging CT technologies. The purpose of this work was to show that 3D tomographic patient models can be generated from two-view scout images using deep learning strategies, and the reconstructed 3D patient models indeed enable accurate prescriptions of fluence-field modulated or organ-specific dose delivery in the subsequent CTscans. CT images and the corresponding two-view scout images were retrospectively collected from 4214 individual CT exams. The collected data were curated for the training of a deep neural network architecture termed ScoutCT-NET to generate 3D tomographic attenuation models from two-view scout images. The trained network was validated using a cohort of 55136 images from 212 individual patients. To evaluate the accuracy of the reconstructed 3D patient models, radiation delivery plans were generated using ScoutCT-NET 3D patient models and compared with plans prescribed based on true CT images (gold standard) for both fluence-field-modulated CT and organ-specific CT. Radiation dose distributions were estimated using Monte Carlo simulations and were quantitatively evaluated using the Gamma analysis method. Modulated dose profiles were compared against state-of-the-art tube current modulation schemes. Impacts of ScoutCT-NET patient model-based dose modulation schemes on universal-purpose CT acquisitions and organ-specific acquisitions were also compared in terms of overall image appearance, noise magnitude, and noiseuniformity. The results demonstrate that (1) The end-to-end trained ScoutCT-NET can be used to generate 3D patient attenuation models and demonstrate empirical generalizability. (2) The 3D patient models can be used to accurately estimate the spatial distribution of radiation dose delivered by standard helical CTs prior to the actual CT acquisition; compared to the gold-standard dose distribution, 95.0% of the voxels in the ScoutCT-NET based dose maps have acceptable gamma values for 5 mm distance-to-agreement and 10% dose difference. (3) The 3D patient models also enabled accurate prescription of fluence-field modulated CT to generate a more uniform noise distribution across the patient body compared to tube current-modulated CT. (4) ScoutCT-NET 3D patient models enabled accurate prescription of organ-specific CT to boost image quality for a given body region-of-interest under a given radiation doseconstraint. 3D tomographic attenuation models generated by ScoutCT-NET from two-view scout images can be used to prescribe fluence-field-modulated or organ-specific CT scans with high accuracy for the overall objective of radiation dose reduction or image quality improvement for a given imagingtask.

Validation of a deterministic linear Boltzmann transport equation solver for rapid CT dose computation using physical dose measurements in pediatric phantoms.

The risk of inducing cancer to patients undergoing CT examinations has motivated efforts for CT dose estimation, monitoring, and reduction, especially among pediatric population. The method investigated in this study is Acuros CTD (Varian Medical Systems, Palo Alto, CA), a deterministic linear Boltzmann transport equation (LBTE) solver aimed at generating rapid and reliable dose maps of CT exams. By applying organ contours, organ doses can also be obtained, thus patient-specific organ dose estimates can be provided. This study experimentally validated Acuros against measurements performed on a clinical CT system using a range of physical pediatric anthropomorphic phantoms and acquisition protocols. The study consisted of (1) the acquisition of dose measurements on a clinical CT scanner through thermoluminescent dosimeters (TLDs), and (2) the modeling in the Acuros platform of the measurement set up, which includes the modeling of the CT scanner and of the anthropomorphic phantoms. For the measurements, 1-year-old, 5-year-old, and 10-year-old anthropomorphic phantoms of the CIRS ATOM family were used. TLDs were placed in selected organ locations such as stomach, liver, lungs, and heart. The pediatric phantoms were scanned helically with the GE Discovery 750 HD clinical scanner for several examination protocols. For the simulations in Acuros, scanner-specific input, such as bowtie filters, overrange collimation, and tube current modulation schemes, were modeled. These scanner complexities were implemented by defining discretized X-ray beams whose spectral distribution, defined in Acuros by only six energy bins, varied across fan angle, cone angle, and slice position. The images generated during the CT acquisitions were used to create the geometrical models, by applying thresholding algorithms and assigning materials to the HU values. The TLDs were contoured in the phantom models as sensitive cylindrical volumes at the locations selected for dosimeters placement, to provide dose estimates, in terms of dose per unit photon. To compare measured doses with dose estimates, a calibration factor was derived from the CTDIvol displayed by the scanner, to account for the number of photons emitted by the X-ray tube during the procedure. The differences of the measured and estimated doses, in terms of absolute % errors, were within 13% for 153 TLD locations, with an error of 17% at the stomach for one study with the 10-year-old phantom. Root-mean-squared-errors (RMSE) across all TLD locations for all configurations were in the range of 3%-8%, with Acuros providing dose estimates in a time range of a few seconds up to 2 min. An overall good agreement between measurements and simulations was achieved, with average RMSE of 6% across all cases. The results demonstrate that Acuros can model a specific clinical scanner despite the required discretization in spatial and energy domains. The proposed deterministic tool has the potential to be part of a near real-time individualized dosimetry monitoring system for CT applications, providing patient-specific organ dose estimates.

Reference dataset for benchmarking fetal doses derived from Monte Carlo simulations of CT exams.

Task Group Report 195 of the American Association of Physicists in Medicine contains reference datasets for the direct comparison of results among different Monte Carlo (MC) simulation tools for various aspects of imaging research that employs ionizing radiation. While useful for comparing and validating MC codes, that effort did not provide the information needed to compare absolute dose estimates from CT exams. Therefore, the purpose of this work is to extend those efforts by providing a reference dataset for benchmarking fetal dose derived from MC simulations of clinical CT exams. The reference dataset contains the four necessary elements for validating MC engines for CT dosimetry: (a) physical characteristics of the CT scanner, (b) patient information, (c) exam specifications, and (d) fetal dose results from previously validated and published MC simulations methods in tabular form. Scanner characteristics include non-proprietary descriptions of equivalent source cumulative distribution function (CDF) spectra and bowtie filtration profiles, as well as scanner geometry information. Additionally, for the MCNPX MC engine, normalization factors are provided to convert raw simulation results to absolute dose in mGy. The patient information is based on a set of publicly available fetal dose models and includes de-identified image data; voxelized MC input files with fetus, uterus, and gestational sac identified; and patient size metrics in the form of water equivalent diameter (Dw ) z-axis distributions from a simulated topogram (Dw,topo ) and from the image data (Dw,image ). Exam characteristics include CT scan start and stop angles and table and patient locations, helical pitch, nominal collimation and measured beam width, and gantry rotation time for each simulation. For simulations involving estimating doses from exams using tube current modulation (TCM), a realistic TCM scheme is presented that is estimated based upon a validated method. (d) Absolute and CTDIvol -normalized fetal dose results for both TCM and FTC simulations are given for each patient model under each scan scenario. Equivalent source CDFs and bowtie filtration profiles are available in text files. Image data are available in DICOM format. Voxelized models are represented by a header followed by a list of integers in a text file representing a three-dimensional model of the patient. Size distribution metrics are also given in text files. Results of absolute and normalized fetal dose with associated MC error estimates are presented in tabular form in an Excel spreadsheet. All data are stored on Zenodo and are publicly accessible using the following link: https://zenodo.org/record/3959512. Similar to the work of AAPM Report 195, this work provides a set of reference data for benchmarking fetal dose estimates from clinical CT exams. This provides researchers with an opportunity to compare MC simulation results to a set of published reference data as part of their efforts to validate absolute and normalized fetal dose estimates. This could also be used as a basis for comparison to other non-MC approaches, such as deterministic approaches, or to commercial packages that provide estimates of fetal doses from clinical CT exams.

VALIDATION OF MONTE CARLO DOSE CALCULATION FOR PAEDIATRIC CT EXAMINATIONS USING TUBE CURRENT MODULATION BASED ON IN-PHANTOM DOSIMETRY.

The aim of this study is to estimate tube current modulation (TCM) profiles in paediatric computed tomography (CT) examinations with a TCM scheme (Volume-EC) and evaluate the estimation accuracy of TCM profiles. Another aim is to validate organ doses calculated using Monte Carlo-based CT dosimetry software and estimated TCM profiles by comparing them with those measured using 5-year-old and 10-year-old anthropomorphic phantoms and radio-photoluminescence glass dosemeters. Dose calculations were performed by inputting detailed descriptions of a CT scanner, scan parameters and CT images of the phantoms into the software. Organ doses were evaluated from the calculated dose distribution images. Average relative differences (RDs) between the estimated and actual TCM profiles ranged from -3.6 to 5.6%. RDs between the calculated and measured organ doses ranged from -4.2 to 13.0% and -18.1 to 4.9% for 5-year-old and 10-year-old phantoms, respectively. These results validate dose calculations for paediatric CT scans using TCM.

TU‐H‐207A‐06: The Effects of Various CT Tube Current Modulation (TCM) Schemes On Dose. Do You Really Know What Your TCM Scheme Is Doing?

Purpose:To compare the effects of various tube current modulation (TCM) schemes – including attenuation‐based, “organ‐based” and combined schemes ‐ on both the resulting tube current values as well as dose savings.Methods:An anthropomorphic adult thorax phantom was scanned using a Multidetector row CT scanner that offered both attenuation‐based and “organ‐based” TCM schemes that could be used separately or in combination (Definition AS64, Siemens Healthcare). A small ion chamber was attached to a medial location on the surface of the chest phantom to provide a reference value which served as proxy for organ dose. Scans were performed under each possible TCM configuration (fixed mA, attenuationbased only, organ‐based only and combined organ and attenuation based) using the same nominal parameters (e.g. Quality Reference mAs). The actual TCM scheme was extracted from the raw projection data of each scan to illustrate the actual mA variations. The scanner CTDIvol and ion chamber readings were recorded for each scan and comparisons were made across TCM schemes.Results:Each of the TCM schemes showed substantially different mA patterns. All TCM schemes showed some reduction in CTDIvol compared to a fixed mA scan with the same nominal settings; however the values ranged from a decrease of 2% (organ based only) to 18% (attenuation based only). The dose reduction to the surface dose point varied from a decrease of 34% (organ based only) to an increase of 15% (attenuation based only) compared to the fixed mA scan. Examining the actual TCM schemes from the raw data files allows us to understand the effects of each scheme.Conclusion:Phantom scans allowed us to compare the effects of different TCM schemes on both CTDIvol values as well as point doses. Future work will focus on organ doses from each scheme using validated Monte Carlo techniques.

TU‐H‐207A‐08: Estimating Radiation Dose From Low‐Dose Lung Cancer Screening CT Exams Using Tube Current Modulation

Purpose:The purpose of this work is to estimate effective and lung doses from a low‐dose lung cancer screening CT protocol using Tube Current Modulation (TCM) across patient models of different sizes.Methods:Monte Carlo simulation methods were used to estimate effective and lung doses from a low‐dose lung cancer screening protocol for a 64‐slice CT (Sensation 64, Siemens Healthcare) that used TCM. Scanning parameters were from the AAPM protocols. Ten GSF voxelized patient models were used and had all radiosensitive organs identified to facilitate estimating both organ and effective doses. Predicted TCM schemes for each patient model were generated using a validated method wherein tissue attenuation characteristics and scanner limitations were used to determine the TCM output as a function of table position and source angle. The water equivalent diameter (WED) was determined by estimating the attenuation at the center of the scan volume for each patient model. Monte Carlo simulations were performed using the unique TCM scheme for each patient model. Lung doses were tallied and effective doses were estimated using ICRP 103 tissue weighting factors. Effective and lung dose values were normalized by scanspecific 32 cm CTDIvol values based upon the average tube current across the entire simulated scan. Absolute and normalized doses were reported as a function of WED for each patient.Results:For all ten patients modeled, the effective dose using TCM protocols was below 1.5 mSv. Smaller sized patient models experienced lower absolute doses compared to larger sized patients. Normalized effective and lung doses showed some dependence on patient size (R2 = 0.77 and 0.78, respectively).Conclusion:Effective doses for a low‐dose lung screening protocol using TCM were below 1.5 mSv for all patient models used in this study.Institutional research agreement, Siemens Healthcare; Past recipient, research grant support, Siemens Healthcare; Consultant, Toshiba America Medical Systems; Consultant, Samsung Electronics

Task-Driven Tube Current Modulation and Regularization Design in Computed Tomography with Penalized-Likelihood Reconstruction.

This work applies task-driven optimization to design CT tube current modulation and directional regularization in penalized-likelihood (PL) reconstruction. The relative performance of modulation schemes commonly adopted for filtered-backprojection (FBP) reconstruction were also evaluated for PL in comparison. We adopt a task-driven imaging framework that utilizes a patient-specific anatomical model and information of the imaging task to optimize imaging performance in terms of detectability index (d'). This framework leverages a theoretical model based on implicit function theorem and Fourier approximations to predict local spatial resolution and noise characteristics of PL reconstruction as a function of the imaging parameters to be optimized. Tube current modulation was parameterized as a linear combination of Gaussian basis functions, and regularization was based on the design of (directional) pairwise penalty weights for the 8 in-plane neighboring voxels. Detectability was optimized using a covariance matrix adaptation evolutionary strategy algorithm. Task-driven designs were compared to conventional tube current modulation strategies for a Gaussian detection task in an abdomen phantom. The task-driven design yielded the best performance, improving d' by ~20% over an unmodulated acquisition. Contrary to FBP, PL reconstruction using automatic exposure control and modulation based on minimum variance (in FBP) performed worse than the unmodulated case, decreasing d' by 16% and 9%, respectively. This work shows that conventional tube current modulation schemes suitable for FBP can be suboptimal for PL reconstruction. Thus, the proposed task-driven optimization provides additional opportunities for improved imaging performance and dose reduction beyond that achievable with conventional acquisition and reconstruction.

GMctdospp: Description and validation of a CT dose calculation system.

To develop a Monte Carlo (MC)-based computed tomography (CT) dose estimation method with a graphical user interface with options to define almost arbitrary simulation scenarios, to make calculations sufficiently fast for comfortable handling, and to make the software free of charge for general availability to the scientific community. A framework called GMctdospp was developed to calculate phantom and patient doses with the MC method based on the EGSnrc system. A CT scanner was modeled for testing and was adapted to half-value layer, beam-shaping filter, z-profile, and tube-current modulation (TCM). To validate the implemented variance reduction techniques, depth-dose and cross-profile calculations of a static beam were compared against DOSXYZnrc/EGSnrc. Measurements for beam energies of 80 and 120 kVp at several positions of a CT dose-index (CTDI) standard phantom were compared against calculations of the created CT model. Finally, the efficiency of the adapted code was benchmarked against EGSnrc defaults. The CT scanner could be modeled accurately. The developed TCM scheme was confirmed by the dose measurement. A comparison of calculations to DOSXYZnrc showed no systematic differences. Measurements in a CTDI phantom could be reproduced within 2% average, with a maximal difference of about 6%. Efficiency improvements of about six orders of magnitude were observed for larger organ structures of a chest-examination protocol in a voxelized phantom. In these cases, simulations took 25 s to achieve a statistical uncertainty of ∼0.5%. A fast dose-calculation system for phantoms and patients in a CT examination was developed, successfully validated, and benchmarked. Influences of scan protocols, protection method, and other issues can be easily examined with the developed framework.

TU‐EF‐204‐01: Accurate Prediction of CT Tube Current Modulation: Estimating Tube Current Modulation Schemes for Voxelized Patient Models Used in Monte Carlo Simulations

Purpose:Most patient models used in Monte Carlo‐based estimates of CT dose, including computational phantoms, do not have tube current modulation (TCM) data associated with them. While not a problem for fixed tube current simulations, this is a limitation when modeling the effects of TCM. Therefore, the purpose of this work was to develop and validate methods to estimate TCM schemes for any voxelized patient model.Methods:For 10 patients who received clinically‐indicated chest (n=5) and abdomen/pelvis (n=5) scans on a Siemens CT scanner, both CT localizer radiograph (“topogram”) and image data were collected. Methods were devised to estimate the complete x‐y‐z TCM scheme using patient attenuation data: (a) available in the Siemens CT localizer radiograph/topogram itself (“actual‐topo”) and (b) from a simulated topogram (“sim‐topo”) derived from a projection of the image data. For comparison, the actual TCM scheme was extracted from the projection data of each patient. For validation, Monte Carlo simulations were performed using each TCM scheme to estimate dose to the lungs (chest scans) and liver (abdomen/pelvis scans). Organ doses from simulations using the actual TCM were compared to those using each of the estimated TCM methods (“actual‐topo” and “sim‐topo”).Results:For chest scans, the average differences between doses estimated using actual TCM schemes and estimated TCM schemes (“actual‐topo” and “sim‐topo”) were 3.70% and 4.98%, respectively. For abdomen/pelvis scans, the average differences were 5.55% and 6.97%, respectively.Conclusion:Strong agreement between doses estimated using actual and estimated TCM schemes validates the methods for simulating Siemens topograms and converting attenuation data into TCM schemes. This indicates that the methods developed in this work can be used to accurately estimate TCM schemes for any patient model or computational phantom, whether a CT localizer radiograph is available or not.Funding Support: NIH Grant R01‐EB017095; Disclosures ‐ Michael McNitt‐Gray: Institutional Research Agreement, Siemens AG; Research Support, Siemens AG; Consultant, Flaherty Sensabaugh Bonasso PLLC; Consultant, Fulbright and Jaworski; Disclosures ‐ Cynthia McCollough: Research Grant, Siemens Healthcare

Prospective estimation of organ dose in CT under tube current modulation.

Computed tomography (CT) has been widely used worldwide as a tool for medical diagnosis and imaging. However, despite its significant clinical benefits, CT radiation dose at the population level has become a subject of public attention and concern. In this light, optimizing radiation dose has become a core responsibility for the CT community. As a fundamental step to manage and optimize dose, it may be beneficial to have accurate and prospective knowledge about the radiation dose for an individual patient. In this study, the authors developed a framework to prospectively estimate organ dose for chest and abdominopelvic CT exams under tube current modulation (TCM). The organ dose is mainly dependent on two key factors: patient anatomy and irradiation field. A prediction process was developed to accurately model both factors. To model the anatomical diversity and complexity in the patient population, the authors used a previously developed library of computational phantoms with broad distributions of sizes, ages, and genders. A selected clinical patient, represented by a computational phantom in the study, was optimally matched with another computational phantom in the library to obtain a representation of the patient's anatomy. To model the irradiation field, a previously validated Monte Carlo program was used to model CT scanner systems. The tube current profiles were modeled using a ray-tracing program as previously reported that theoretically emulated the variability of modulation profiles from major CT machine manufacturers Li et al., [Phys. Med. Biol. 59, 4525-4548 (2014)]. The prediction of organ dose was achieved using the following process: (1) CTDIvol-normalized-organ dose coefficients (horgan) for fixed tube current were first estimated as the prediction basis for the computational phantoms; (2) each computation phantom, regarded as a clinical patient, was optimally matched with one computational phantom in the library; (3) to account for the effect of the TCM scheme, a weighted organ-specific CTDIvol [denoted as CTDIvol organ,weighted] was computed for each organ based on the TCM profile and the anatomy of the "matched" phantom; (4) the organ dose was predicted by multiplying the weighted organ-specific CTDIvol with the organ dose coefficients (horgan). To quantify the prediction accuracy, each predicted organ dose was compared with the corresponding organ dose simulated from the Monte Carlo program with the TCM profile explicitly modeled. The predicted organ dose showed good agreements with the simulated organ dose across all organs and modulation profiles. The average percentage error in organ dose estimation was generally within 20% across all organs and modulation profiles, except for organs located in the pelvic and shoulder regions. For an average CTDIvol of a CT exam of 10 mGy, the average error at full modulation strength (α = 1) across all organs was 0.91 mGy for chest exams, and 0.82 mGy for abdominopelvic exams. This study developed a quantitative model to predict organ dose for clinical chest and abdominopelvic scans. Such information may aid in the design of optimized CT protocols in relation to a targeted level of image quality.

The impact on CT dose of the variability in tube current modulation technology: a theoretical investigation

Body CT scans are routinely performed using tube-current-modulation (TCM) technology. There is notable variability across CT manufacturers in terms of how TCM technology is implemented. Some manufacturers aim to provide uniform image noise across body regions and patient sizes, whereas others aim to provide lower noise for smaller patients. The purpose of this study was to conduct a theoretical investigation to understand how manufacturer-dependent TCM scheme affects organ dose, and to develop a generic approach for assessing organ dose across TCM schemes. The adult reference female extended cardiac-torso (XCAT) phantom was used for this study. A ray-tracing method was developed to calculate the attenuation of the phantom for a given projection angle based on phantom anatomy, CT system geometry, x-ray energy spectrum, and bowtie filter filtration. The tube current (mA) for a given projection angle was then calculated as a log-linear function of the attenuation along that projection. The slope of this function, termed modulation control strength, α, was varied from 0 to 1 to emulate the variability in TCM technology. Using a validated Monte Carlo program, organ dose was simulated for five α values (α = 0, 0.25, 0.5, 0.75, and 1) in the absence and presence of a realistic system mA limit. Organ dose was further normalized by volume-weighted CT dose index (CTDIvol) to obtain conversion factors (h factors) that are relatively independent of system specifics and scan parameters. For both chest and abdomen-pelvis scans and for 24 radiosensitive organs, organ dose conversion factors varied with α, following second-order polynomial equations. This result suggested the need for α-specific organ dose conversion factors (i.e., conversion factors specific to the modulation scheme used). On the other hand, across the full range of α values, organ dose in a TCM scan could be derived from the conversion factors established for a fixed-mA scan (hFIXED). This was possible by multiplying hFIXED by a revised definition of CTDIvol that accounts for two factors: (a) the tube currents at the location of an organ and (b) the variation in organ volume along the longitudinal direction. This α-generic approach represents an approximation. The error associated with this approximation was evaluated using the α-specific organ dose (i.e., the organ dose obtained by using α-specific mA profiles as inputs into the Monte Carlo simulation) as the reference standard. When the mA profiles were constrained by a realistic system limit, this α-generic approach had errors of less than ~20% for the full range of α values. This was the case for 24 radiosensitive organs in both chest and abdomen-pelvis CT scans with the exception of thyroid in the chest scan and bladder in the abdomen-pelvis scan. For these two organs, the errors were less than ~40%. The results of this theoretical study suggested that knowing the mA modulation profile and the fixed-mA conversion factors, organ dose may be estimated for a TCM scan independent of the specific modulation scheme applied.

Fetal doses to pregnant patients from CT with tube current modulation calculated using Monte Carlo simulations and realistic phantoms

To investigate the radiation dose to the fetus using retrospective tube current modulation (TCM) data selected from archived clinical records. This paper describes the calculation of fetal doses using retrospective TCM data and Monte Carlo (MC) simulations. Three TCM schemes were adopted for use with three pregnant patient phantoms. MC simulations were used to model CT scanners, TCM schemes and pregnant patients. Comparisons between organ doses from TCM schemes and those from non-TCM schemes show that these three TCM schemes reduced fetal doses by 14, 18 and 25 %, respectively. These organ doses were also compared with those from ImPACT calculation. It is found that the difference between the calculated fetal dose and the ImPACT reported dose is as high as 46 %. This work demonstrates methods to study organ doses from various TCM protocols and potential ways to improve the accuracy of CT dose calculation for pregnant patients.

A database for estimating organ dose for coronary angiography and brain perfusion CT scans for arbitrary spectra and angular tube current modulation

The purpose of this study was to develop a database for estimating organ dose in a voxelized patient model for coronary angiography and brain perfusion CT acquisitions with any spectra and angular tube current modulation setting. The database enables organ dose estimation for existing and novel acquisition techniques without requiring Monte Carlo simulations. The study simulated transport of monoenergetic photons between 5 and 150 keV for 1000 projections over 360° through anthropomorphic voxelized female chest and head (0° and 30° tilt) phantoms and standard head and body CTDI dosimetry cylinders. The simulations resulted in tables of normalized dose deposition for several radiosensitive organs quantifying the organ dose per emitted photon for each incident photon energy and projection angle for coronary angiography and brain perfusion acquisitions. The values in a table can be multiplied by an incident spectrum and number of photons at each projection angle and then summed across all energies and angles to estimate total organ dose. Scanner-specific organ dose may be approximated by normalizing the database-estimated organ dose by the database-estimated CTDI(vol) and multiplying by a physical CTDI(vol) measurement. Two examples are provided demonstrating how to use the tables to estimate relative organ dose. In the first, the change in breast and lung dose during coronary angiography CT scans is calculated for reduced kVp, angular tube current modulation, and partial angle scanning protocols relative to a reference protocol. In the second example, the change in dose to the eye lens is calculated for a brain perfusion CT acquisition in which the gantry is tilted 30° relative to a nontilted scan. Our database provides tables of normalized dose deposition for several radiosensitive organs irradiated during coronary angiography and brain perfusion CT scans. Validation results indicate total organ doses calculated using our database are within 1% of those calculated using Monte Carlo simulations with the same geometry and scan parameters for all organs except red bone marrow (within 6%), and within 23% of published estimates for different voxelized phantoms. Results from the example of using the database to estimate organ dose for coronary angiography CT acquisitions show 2.1%, 1.1%, and -32% change in breast dose and 2.1%, -0.74%, and 4.7% change in lung dose for reduced kVp, tube current modulated, and partial angle protocols, respectively, relative to the reference protocol. Results show -19.2% difference in dose to eye lens for a tilted scan relative to a nontilted scan. The reported relative changes in organ doses are presented without quantification of image quality and are for the sole purpose of demonstrating the use of the proposed database. The proposed database and calculation method enable the estimation of organ dose for coronary angiography and brain perfusion CT scans utilizing any spectral shape and angular tube current modulation scheme by taking advantage of the precalculated Monte Carlo simulation results. The database can be used in conjunction with image quality studies to develop optimized acquisition techniques and may be particularly beneficial for optimizing dual kVp acquisitions for which numerous kV, mA, and filtration combinations may be investigated.

SU‐E‐I‐54: A Database for Estimating Scanner‐Specific CT Organ Dose

Purpose: To develop a database for estimating scanner‐specific organ dose in a voxelized patient model for any spectral shape and angular tube current modulation setting. The database enables the estimation of organ dose for both existing and novel acquisition techniques without requiring Monte Carlo simulations. Methods: The transport of monoenergetic photons through three phantoms was simulated with the PENELOPE Monte Carlo radiation transport routines at 5 – 150 keV in 1 keV increments at 1000 projections in 0.36 degree increments. The source‐to‐detector distance for each simulation was 100 cm, with a source‐to‐isocenter distance of 50 cm. The lateral and axial extents of the detector were 100 cm and 16 cm respectively, while the detector pixel resolution was 0.25 mm. The first phantom was a 0.5 mm resolution anthropomorphic voxelized female phantom, while the other two phantoms were standard head and chest CTDI cylinders modeled using mathematical quadrics. Results: The simulations resulted in a normalized dose deposition table for numerous organs quantifying the typical dose deposited in the organ per emitted photon for each energy level and projection angle. The values in this table can be multiplied by an incident spectrum and number of photons at each projection angle and summed across all energies and angles to estimate the total organ dose. Similarly, the CTDIvol for a particular acquisition can be estimated from the dose deposition tables for the CTDI phantoms. The estimated CTDIvol can be used along with a physical CTDIvol measurement to convert the organ dose calculated from the database to a scanner specific estimate. Conclusions: The proposed database and procedure enable the estimation of scanner‐specific organ dose for CT scans utilizing any spectral shape and angular tube current modulation scheme without requiring Monte Carlo simulations.This project is funded in part by the US Food and Drug Administration, Office of Womenˈs Health (OWH), and by the Oak Ridge Institute of Science and Engineering (ORISE). Performance of Monte Carlo simulations were made possible by NSF grant OCI‐0923037.

X-ray tube current modulation and patient doses in chest CT

The aim of the study was to investigate how patient effective doses vary as a function of X-ray tube projection angle, as well as the patient long axis, and quantify how X-ray tube current modulation affects patient doses in chest CT examinations. Chest examinations were simulated for a gantry CT scanner geometry with projections acquired for a beam width of 4 cm. PCXMC 2.0.1 was used to calculate patient effective doses at 15° intervals around the patient's isocentre, and at nine locations along the patient long axis. Idealised tube current modulation schemes were modelled as a function of the X-ray tube angle and the patient long axis. Tube current modulations were characterised by the modulation amplitude R, which was allowed to vary between 1.5 and 5. Effective dose maxima occur for anteroposterior projections at the location of the (radiosensitive) breasts. The maximum to minimum ratio of effective doses as a function of the patient long axis was 4.9, and as a function of the X-ray tube angle was 2.1. Doubling the value of R reduces effective doses from longitudinal modulation alone by ∼4% and from angular modulation alone by ∼2%. In chest CT, tube current modulation schemes currently have longitudinal R values of ∼2.2, and angular R values that range between 1.5 and 3.4. Current X-ray tube current modulation schemes are expected to reduce patient effective doses in chest CT examinations by ∼10%, with longitudinal modulation accounting for two-thirds and angular modulation for the remaining one-third.

MO‐SAM‐201B‐01: Optimizing CT Dose and Image Quality for Different Patient Sizes

CT technology has improved dramatically over the past decade and its clinical utilization has increased significantly as well. While CT can yield exquisite descriptions of anatomy that were not previously possible (at least not with noninvasive techniques), its increased utilization has led concerns over radiation dose; CT has now been identified as the single largest contributor to medical radiation dose to the population and accounts for approximately 50% of medical exposure. Methods to reduce radiation dose have been the focus of all stakeholders (medical physicists, technologists, radiologists, manufacturers and regulators). Reducing dose while maintaining acceptable image quality can be complex and this is made even more complex when considering patients of different sizes.This talk will first describe methods currently used, and some being developed, to estimate radiation dose in patients. This will include a discussion of measurement techniques as well as Monte Carlo simulation‐based techniques. Specific attention will be paid to the differences in dose to patients of different sizes ranging from pediatric patients to obese adult patients. Tradeoffs in image quality and radiation dose will also be described in this context as well. Radiation dose reduction techniques, including a review of various tube current modulation schemes currently being employed will also be described. The effect of these dose reduction methods on both radiation dose and image quality will be discussed, again with attention to how they can be deployed with patients of different size.Learning Objectives:1. Understand how radiation dose for CT studies is currently estimated2. Understand the trade‐offs of dose and image quality, especially for large (obese) patients and in pediatric patients3. Review of the manufacturers' dose modulation methods and how these affect dose in different patients

TH-C-201B-12: CT Dose Reduction with Tube Current Modulation: A Case Study of Fetal Doses to Pregnant Patients Using Monte Carlo Computational Phantoms

Purpose: To demonstrate CT fetal dose reduction with the use of tube current modulation (TCM) on pregnant patients using retrospective data. Method and Materials:Monte Carlo(MC) simulation techniques are used to model CT scanners the TCM schemes and the pregnant patients. Two MDCT scanners GE LightSpeed Pro 16 and GE LightSpeed™ 16 were modeled in MCNPX source code. The TCM data were selected from archived clinical records for pregnant patients who underwent CT procedures recently at Massachusetts General Hospital (MGH) in Boston. Three pregnant patient phantoms with different gestations were utilized. Results: According to the calculation results it is found that the fetal dose from TCM is always smaller than the fetal dose from non‐TCM. TCM schema can reduce fetal dose from 14% to 25%. Also fetal dose gets increased when fetus becomes larger. It is also found that results of ImPACT calculations are always larger than MC calculations performed in this research. The difference between the two sets of data can reach around 40%–50%. Conclusion: This work demonstrates that Monte Carlo method can be used to assess the organ doses and fetal doses of pregnant patients undergoing TCM CT examinations by modeling the CT scanner and TCM schema as well as patient phantoms. The comparison between TCM organ doses and non‐TCM organ doses indicates that the modulated current can effectively help reduce organ dose from CT scans from 14% to 25% according to the specific TCM schema.

MO‐SAM‐304A‐01: Optimizing CT Dose and Image Quality for Different Patient Sizes

CT technology has improved dramatically over the past decade and its clinical utilization has increased significantly as well. While CT can yield exquisite descriptions of anatomy that were not previously possible (at least not with noninvasive techniques), its increased utilization has led concerns over radiation dose; CT has now been identified as the single largest contributor to medical radiation dose to the population and accounts for approximately 50% of medical exposure. Methods to reduce radiation dose have been the focus of all stakeholders (medical physicists, technologists, radiologists, manufacturers and regulators). Reducing dose while maintaining acceptable image quality can be complex and this is made even more complex when considering patients of different sizes. This talk will first describe methods currently used, and some being developed, to estimate radiation dose in patients. This will include a discussion of measurement techniques as well as Monte Carlo simulation‐based techniques. Specific attention will be paid to the differences in dose to patients of different sizes ranging from pediatric patients to obese adult patients. Tradeoffs in image quality and radiation dose will also be described in this context as well. Radiation dose reduction techniques, including a review of various tube current modulation schemes currently being employed will also be described. The effect of these dose reduction methods on both radiation dose and image quality will be discussed, again with attention to how they can be deployed with patients of different size.Learning Objectives:1. Understand how radiation dose for CT studies is currently estimated2. Understand the trade‐offs of dose and image quality, especially for large (obese) patients and in pediatric patients3. Review of the manufacturers' dose modulation methods and how these affect dose in different patients

CT DOSE: HOW TO MEASURE, HOW TO REDUCE

The fundamental radiation dose parameter in computed tomography (CT) is the CT dose index (CTDI), which is an integral under the radiation dose profile of a single axial scan normalized to the nominal x-ray beam width. It estimates the average dose from a multiple-scan examination and is a directly measurable and standardized quantity. From this information, the dose length product (DLP) is calculated, which estimates the total dose delivered over a specific scan length. Finally, effective dose can be estimated and used to reflect the risk of a non-uniform exposure in terms of a whole-body exposure. To manage dose from CT while maintaining diagnostic image quality, scanner manufacturers have implemented tube current modulation, which may occur angularly around the patient, along the long axis of the patient, or both. Dose reductions of 20 to 50% have been reported using tube current modulation schemes. In the past two decades, the capabilities of CT imaging have expanded tremendously, including narrower image widths, improved temporal and spatial resolution, shorter scan times, and cardiac imaging techniques. Yet, the dose per typical exam (e.g., routine abdominal CT) has decreased by a factor of two or more over the same time period. Therefore, patients should be reassured that the benefits of medically-justified and appropriately-performed CT examinations are associated with radiation doses that continue to decrease as technology continues to evolve.

Validation of a Monte Carlo tool for patient-specific dose simulations in multi-slice computed tomography

Estimating the dose delivered to the patient in X-ray computed tomography (CT) examinations is not a trivial task. Monte Carlo (MC) methods appear to be the method of choice to assess the 3D dose distribution. The purpose of this work was to extend an existing MC-based tool to account for arbitrary scanners and scan protocols such as multi-slice CT (MSCT) scanners and to validate the tool in homogeneous and heterogeneous phantoms. The tool was validated by measurements on MSCT scanners for different scan protocols under known conditions. Quantitative CT Dose Index (CTDI) measurements were performed in cylindrical CTDI phantoms and in anthropomorphic thorax phantoms of various sizes; dose profiles were measured with thermoluminescent dosimeters (TLD) in the CTDI phantoms and compared with the computed dose profiles. The in-plane dose distributions were simulated and compared with TLD measurements in an Alderson-Rando phantom. The calculated dose values were generally within 10% of measurements for all phantoms and all investigated conditions. Three-dimensional dose distributions can be accurately calculated with the MC tool for arbitrary scanners and protocols including tube current modulation schemes. The use of the tool has meanwhile also been extended to further scanners and to flat-detector CT.